INTERPERSONAL PROFESSIONAL RELATIONSHIPS COMPETENCY
Rating Form
Trainee Name:
Name of Placement:
Name of Person Completing Form (please include
highest degree earned):
Date Evaluation Completed:
Licensed Psychologist: Yes No
Was this trainee supervised by individuals also under
your supervision? Yes No
Type of Review:
Initial Review
Mid-placement
review
Final Review
Other (please describe):
Dates of Training Experience this Review Covers: _____
Training Level of Person Being Assessed: Year in Doctoral Program:
Intern:
1
Select the column corresponding to the training level of the person being assessed. Rate items in that column by responding to the following
question using the scale below:
How characteristic of the trainee’s behavior is this competency description?
Not at All/Slightly
Somewhat
Moderately
Mostly
Very
0
1
2
3
4
If you have not had the opportunity to observe a behavior in question, please indicate this by circling “No Opportunity to Observe” [N/O].
Interpersonal Professional Relationships - Establishes, develops, and maintains effective interpersonal, professional relationships
with clients1, supervisors, supervisees, faculty, peers, support staff, allied professionals, organizations, and communities (e.g.,
effective working alliances/therapeutic relationships with clients, supervisory relationships that foster the growth and development of
supervisees and facilitate client progress)
READINESS FOR PRACTICUM
READINESS FOR INTERNSHIP
READINESS FOR ENTRY TO PRACTICE
1. Empathy, Compassion, & Desire to be Helpful
Expresses desire to help others
0
1
2
3
4
[N/O]
Demonstrates compassion (awareness
of suffering and the wish to relieve it)
for others who are similar to oneself
Demonstrates accurate empathy for
feelings that are overtly expressed by
others, in a manner that furthers the
goals of professional activities
Examples: empathy promotes a positive therapeutic
relationship; clients express feeling supported
0
0
1
2
3
4
1
2
3
4
[N/O]
[N/O]
Demonstrates empathic listening,
behavior, and attitude
Demonstrates compassion for others
who are dissimilar from oneself
0
1
2
3
4
[N/O]
Demonstrates accurate empathy for
feelings that are covertly expressed by
others or are outside the awareness of
others, as well as in complex,
challenging and/or novel situations
0
1
2
3
4
[N/O]
Demonstrates compassion for others
who are dissimilar from oneself, who
express negative affect (e.g., hostility),
and/or who seek care for proscribed
behavior, such as violence, predation, or
dangerousness
Examples: accurately reflects others’ feelings
0
0
1
1
2
3
4
1
2
3
4
[N/O]
[N/O]
“Clients” refers to individuals, couples, families, and/or groups
2
Not at All/Slightly = 0
Somewhat = 1
Moderately = 2
READINESS FOR PRACTICUM
Mostly = 3
Very = 4
READINESS FOR INTERNSHIP
No Opp. = [N/O]
READINESS FOR ENTRY TO PRACTICE
2. Experience & Use of Affect
Demonstrates awareness of inner
emotional experience
Attends to own emotional
reactions/clinical intuition in
interpersonal relationships
Uses good clinical judgment regarding
how to use affective reactions
effectively in complex, challenging
and/or novel situations
Examples: uses emotional reactions/clinical intuition to
guide actions in interpersonal relationships in routine
practice and professional relationships
Examples: uses affective reactions in the service of
resolving disagreements or fostering growth in others
Examples: notices and expresses feelings
0
1
2
3
4
[N/O]
Demonstrates emotional maturity
0
0
1
2
3
4
1
2
3
4
[N/O]
[N/O]
Examples: demonstrates comfort with range of emotions;
affect does not overwhelm judgment; resiliency around
distressing affect
0
1
2
3
4
[N/O]
3. Tolerates Affect
Demonstrates general capacity for affect
tolerance, including effectively
managing own affect
Demonstrates affect tolerance in
professional relationships, contexts, and
settings
Examples: demonstrates comfort with others’ affect;
measured vs. impulsive reaction to own feelings;
manages stress
Examples: maintains affective equilibrium and focus on
therapeutic task in face of client distress
0
0
1
2
3
4
[N/O]
Tolerates ambiguity and uncertainty
Examples: is flexible when things don’t go according to
plan
0
1
2
3
4
1
2
3
4
[N/O]
Demonstrates affect tolerance in
professional relationships, contexts, and
settings, even in complex, challenging,
ambiguous and/or novel situations
Examples: tolerates patient’s feelings, attitudes, and
wishes, particularly as they are expressed toward the
therapist, so as to maintain and/or promote therapeutic
dialogue; allows, enables, and facilitates the patient’s
exploration and expression of affectively difficult issues;
works flexibly with patients’ intense affects which could
destabilize the therapeutic relationship
0
1
2
3
4
[N/O]
[N/O]
3
Not at All/Slightly = 0
Somewhat = 1
Moderately = 2
READINESS FOR PRACTICUM
Mostly = 3
Very = 4
READINESS FOR INTERNSHIP
No Opp. = [N/O]
READINESS FOR ENTRY TO PRACTICE
4. Effective Boundary Management
Demonstrates understanding of
appropriate boundaries and displays
general ability to manage boundaries
Demonstrates appropriate use of selfdisclosure
Examples: recognizes differences between personal and
professional relationships; differentiates session content
in the context of one’s own interests and the client’s
therapeutic interests
Examples: uses self-disclosure as a technique in
treatment, shares countertransference reactions with
supervisor, shares personal experiences regarding
diversity issues with supervisors and peers in the service
of group learning
0
0
1
2
3
4
[N/O]
1
2
3
4
[N/O]
Demonstrates appropriate and effective
boundary management in complex,
challenging, and or novel situations with
others
Examples: maintains professional demeanor with clients
who test the limits; proactively understands multiple
roles of self and others and the boundary implications
0
1
2
3
4
[N/O]
Establishes and maintains appropriate
professional boundaries
Examples: begins and ends treatment sessions on time;
establishes expectations regarding fee payment and
addresses nonpayment with clients; establishes clear role
expectations for client; can identify and appropriately
respond to questions from clients, including typical
conversational questions and intrusive questions
0
1
2
3
4
[N/O]
5. Recognizes Effects of Self on Others
Demonstrates sensitivity to the effects
of own identities, behaviors, affects,
attitudes, values, and beliefs on others
Examples: understands aspects of self that affect others,
such as facial expressions or posture; understands that
others may perceive self differently and interpersonal
interactions are shaped by own and others’ identities;
sensitive to the effects of self on others; examines
interactions for effects of self on others
0
1
2
3
4
Demonstrates awareness of the effects
of own identities, behaviors, affects,
attitudes, values, and beliefs on others
in professional situations and contexts
Examples: seeks feedback on ways that behaviors may
affect others; considers how one’s gender and race affect
professional relationships; understands that own
identities and nonverbal behavior have an effect on
others in professional contexts and understands how that
may influence therapy and supervision
[N/O]
0
1
2
3
4
Monitors and evaluates the effects of
own identities, behaviors, affects,
attitudes, values, and beliefs on others
in professional situations and contexts,
and responds accordingly so as to
further professional goals
Examples: uses effects of behavior as part of immediacy
in therapy and supervision; sensitive to the potential
effects of own identities in professional situations and
anticipates potential conflicts due to those effects; open
to supervisor’s feedback about these issues
[N/O]
0
1
2
3
4
[N/O]
4
Not at All/Slightly = 0
Somewhat = 1
Moderately = 2
READINESS FOR PRACTICUM
Mostly = 3
Very = 4
READINESS FOR INTERNSHIP
No Opp. = [N/O]
READINESS FOR ENTRY TO PRACTICE
6. Respectful Interactions with Others [Across Difference]
Shows honesty and integrity; values
ethical behavior
Examples: follows through on commitments; shows care
in speaking about confidential client material; shows
respect for whole client; does not label client
pejoratively; is respectful and considerate in interactions
with support staff
0
1
2
3
4
[N/O]
Respects and shows interest in others’
cultures, experiences, values, points of
view, goals, desires, fears, etc. even
when inconsistent with personal and/or
professional beliefs, experiences,
values, models, etc.
Demonstrates respectful, open
engagement with diverse others (e.g.,
cultural, individual, and role differences,
including those based on age, gender,
gender identity, race, ethnicity, culture,
national origin, religion, sexual
orientation, disability, language, and
socioeconomic status) and
demonstrates adaptation to context
Adapts professional behavior in a
manner that is sensitive and appropriate
to the needs of diverse others
Examples: adapts treatment approach based on diversity
considerations; demonstrates flexibility as various
identities are more or less salient for clients
0
1
2
3
4
[N/O]
Examples: seeks supervision for how to adapt treatment
approach based on diversity considerations;
demonstrates awareness of conflicting identities for
clients and works to adapt treatment approaches flexibly
0
1
2
3
4
[N/O]
Examples: actively participates in course discussions
about diversity issues and welcomes others’
perspectives; develops better understanding of others’
perspectives; able to modify own beliefs/biases
0
1
2
3
4
[N/O]
Interactions reflect basic knowledge of
literatures on individual and cultural
difference, such as racial identity,
acculturation, and historical legacies of
racial/ethnic minorities in the United
States
0
1
2
3
4
[N/O]
5
Not at All/Slightly = 0
Somewhat = 1
Moderately = 2
READINESS FOR PRACTICUM
Mostly = 3
Very = 4
READINESS FOR INTERNSHIP
No Opp. = [N/O]
READINESS FOR ENTRY TO PRACTICE
7. Demonstrates Effective Interpersonal Skills in Challenging Situations
Open-minded
Examples: acknowledges others’ opinions; articulates
more than one perspective in discussions; maintains a
broad belief system; statements reflect acceptance of
diversity of opinions or beliefs
0
1
2
3
4
[N/O]
Tolerates interpersonal conflict
Examples: maintains engagement during interpersonal
conflict; able to process interpersonal conflict; is not
confrontational or dismissive in discussions with others
who have differing opinions
0
1
2
3
4
[N/O]
Addresses problematic interpersonal
situations using verbal and nonverbal
skills
Examples: verbally acknowledges and engages in
discussion of disagreements with colleagues and
instructors; does not deny or minimize problematic
situation when raised; tolerates discussion of problematic
situation without overly hostile or defensive stance;
generates possible resolution strategies or ways to handle
problematic encounters
0
1
2
3
4
Actively addresses problematic
interpersonal situations using verbal
and nonverbal skills
Examples: addresses and works with patients to resolve
strains or ruptures in the therapeutic alliance; initiates
discussion regarding disagreements with colleagues or
supervisors and does so in a timely manner; efforts to
resolve disagreements do not escalate negative affect
among the parties involved; effectively articulates
differences and possible options to resolve; seeks
guidance from appropriate persons
0
1
2
3
4
Effectively negotiates conflictual,
difficult, and complex professional
relationships including those with
individuals and groups that differ
significantly from oneself
Examples: actively seeks others’ opinions; generates
constructive solutions even when others are defensive;
initiates resolution strategies across a variety of settings;
modulates approach to context rather than using the same
skills across situations; knows how to consult about the
process of a problematic interaction as opposed to just
the content of the interaction
[N/O]
0
1
2
3
4
[N/O]
Seeks clarification in challenging
interpersonal communications
Examples: uses active listening and reflection
0
1
2
3
4
[N/O]
Acknowledges own role in difficult
interactions
Examples: makes self-statements reflecting on behavior
0
1
2
3
4
[N/O]
[N/O]
Demonstrates understanding of
different viewpoints in challenging
interactions
Examples: actively and accurately reflects others’
perspectives
0
1
2
3
4
[N/O]
6
Not at All/Slightly = 0
Somewhat = 1
Moderately = 2
READINESS FOR PRACTICUM
Mostly = 3
Very = 4
READINESS FOR INTERNSHIP
No Opp. = [N/O]
READINESS FOR ENTRY TO PRACTICE
8. Open to Providing & Receiving Feedback
Demonstrates willingness to admit
errors
Accepts and implements feedback from
others in a non-defensive manner
Evaluates, negotiates, and implements
feedback from others
Examples: pursues correction of errors rather than
shifting focus to errors of others; acknowledges mistakes
forthrightly
Examples: pursues understanding feedback and learning
how to implement successfully rather than suggesting
ways the feedback isn’t compatible with one’s stance or
other reasons feedback won’t work; listens to
suggestions from supervisor and adapts professional
behavior in accord with supervisory feedback; welcomes
feedback graciously
Examples: engages supervisor in discussion of technique
choice; raises questions and concerns about supervision
and supervisor’s approach as needed; acknowledges
value of feedback even if incompatible with one’s own
views and discusses reasons for incompatibility nondefensively
0
1
2
3
4
[N/O]
Listens to and acknowledges feedback
from others
Examples: acknowledges potential challenges and ways
to overcome challenges; does not demonstrate nonverbal rejection such as changing subjects or giving a
cursory acknowledgement; attentive to others’ ideas and
perspectives on own ideas and work; open to feedback
0
1
2
3
4
[N/O]
0
0
1
2
3
4
1
2
3
4
[N/O]
[N/O]
Provides feedback to others in an
empathic, supportive, non-critical
fashion
Examples: provides feedback to supervisor regarding
supervisory process; provides thoughtful, helpful
feedback to colleagues in case disposition meetings
regarding case conceptualization and clinical technique;
provides effective feedback to clients regarding outcome
of assessment
0
1
2
3
4
[N/O]
9. Cooperation & Collaboration
Demonstrates ability to cooperate with
others
Consults with and collaborates with
others
Examples: works effectively with peers in group
projects; contributes to group discussion; shares own
work; sees the goals and outcomes of group tasks as
accomplishments of the group rather than self
accomplishments; adopts a group identity in working
tasks rather than an individual identity
Examples: evaluates need for and engages in
consultation with allied professionals in the service of
clients; intervenes with external systems on behalf of
clients; shares personal reactions, details, and concerns
about clinical interactions with supervisor in an honest
and full way
0
0
1
2
3
4
[N/O]
1
2
3
4
[N/O]
Collaborates effectively in complex,
challenging, and/or novel situations and
with others who have diverse
perspectives; displays confidence in
what one has to offer in collaboration
with others
Examples: effectively relates to other professionals in
accordance with their unique patient care roles;
maintains own position when appropriate while
acknowledging the value of others’ positions and
initiates mutually accepting resolutions
0
1
2
3
4
[N/O]
7
Not at All/Slightly = 0
Somewhat = 1
Moderately = 2
READINESS FOR PRACTICUM
Mostly = 3
Very = 4
READINESS FOR INTERNSHIP
No Opp. = [N/O]
READINESS FOR ENTRY TO PRACTICE
10. Expressive Skills
Communicates ideas, feelings, and
information clearly using verbal,
nonverbal, and written skills
Communicates clearly using verbal,
nonverbal, and written skills in a
professional context
Examples: written work is organized, easy to understand,
and conveys the main points; shares opinions with others
using language that others can understand; non-verbal
behavior is consistent with verbal communications
Examples: communication is understandable, consistent
across expressive modalities; prepares clearly written
assessment reports; presents clinical process to
supervisor in a succinct, organized, well-summarized
way; provides verbal feedback to client regarding
assessment and diagnosis using language the client can
understand; presents clear, appropriately detailed clinical
material
0
1
2
3
4
[N/O]
0
1
2
3
4
[N/O]
Verbal, nonverbal, and written
communications are informative,
articulate, succinct, sophisticated, and
well-integrated, and demonstrate
thorough grasp of professional language
and concepts
Examples: uses appropriate professional language when
dialoguing with other healthcare providers; prepares
sophisticated and compelling case reports; treatment
summaries are concise, yet comprehensive
0
1
2
3
4
[N/O]
Demonstrates clear understanding and
use of professional language
Examples: uses professional terms and concepts
appropriately and clearly in discussions, case reports,
etc.; understands terms and concepts used in professional
texts and in others’ case reports
0
1
2
3
4
[N/O]
8
Not at All/Slightly = 0
Somewhat = 1
Moderately = 2
READINESS FOR PRACTICUM
Mostly = 3
Very = 4
READINESS FOR INTERNSHIP
No Opp. = [N/O]
READINESS FOR ENTRY TO PRACTICE
11. Awareness of & Commitment to Interpersonal Competence
Demonstrates knowledge and clear
understanding of interpersonal
competencies that are expected in the
field
Examples: reviews Benchmarks document
0
1
2
3
4
Examples: self ratings generally congruent with ratings
by instructors and supervisors
1
2
3
4
Demonstrates clear awareness of own
level of interpersonal professional
competence and limitations
Examples: attends and participates in training seminars
designed to develop and enhance interpersonal skills;
requests and implements feedback from supervisors
regarding interpersonal demeanor and language use
Examples: demonstrates congruence between self ratings
and ratings by supervisors; knowledge of strengths and
weaknesses in interpersonal abilities
0
0
[N/O]
Demonstrates general awareness of
own level of interpersonal professional
competence
0
Uses available resources to improve and
extend interpersonal skills
[N/O]
1
2
3
4
[N/O]
1
2
3
4
[N/O]
Demonstrates commitment to ongoing
growth and development of
interpersonal professional competence
Examples: actively participates in competency
evaluation process and discussions regarding
competencies
0
1
2
3
4
[N/O]
9